The Johns Hopkins Armstrong Institute and VHA
Leadership Accountability Demonstration Project
The Chain of Accountability Model:
Safety Competencies across the Organization Tool
Acknowledgements
The Leadership Accountability Model and tool presented here were developed under funding by the VHA Foundation, contract # 113820, IO# 90052429. Please do not distribute without permission from the authors.
Cite as Goeschel C, Rosen MA, Weaver SJ, Kosel, K., Gelinas, L., Ingle, R., Martin, J., Fawole, J.O., Xinxuan A., Benson K., and Pronovost, P. (2013). The Armstrong Institute and VHA Chain of Accountability Model Workbook.
Table of Contents
Acknowledgements 2
The Armstrong Institute and VHA Model of the Chain of Accountability 4
Building Capacity: Safety Competencies across the Organization 5
Example competencies and development activities across the levels: 5
Safety Competencies across the Organization Tool 6
The Armstrong Institute and VHA Model of the Chain of Accountability
By viewing your organization through the Chain of Accountability lens, you can work to understand where vulnerabilities may be across levels of your organization. You can strengthen the chain by exerting force on three levers: accountability and feedback, capacity, and time and resources.
The tool detailed in this document—Building Capacity: Safety Competencies across the Organization Tool —will help you to define required safety competencies at each level of the organization and plan for systematic and sustainable development strategies. A “safety competency” refers to specific knowledge, an attitude, or a behavioral skill that team members at a given level needs to be able to demonstrate in order to effectively participate in or lead patient safety and quality improvement efforts in your organization.
Building Capacity: Safety Competencies across the Organization
Purpose: Everyone across the organization has a role in improving patient safety. Fulfilling these roles effectively requires specialized skill sets. However, we frequently fail to identify and provide systematic opportunities to develop these skills in healthcare. This tool can help you identify the competencies (i.e., knowledge, attitudes, or behaviors) relevant at each level of your organization, as well as the state of your learning and development infrastructure related to developing identified competency areas.
When to use this tool: When assessing safety infrastructure and yearly after first administration.
How to use this tool: In collaboration with your training and development leaders and representatives across different levels of the organization, determine what competencies staff should have and whether or not they are being provided with opportunities to develop. Example safety competencies and development activities are listed below.
Example competencies and development activities across the levels:
· Frontline staff: Basic exposure to the science of safety; Patient and family centered care; Teamwork training
· Unit Leaders: Safety improvement leadership (RAN or CUSP team training); Patient and family centered care; Lean Sigma (basic course); Knowledge Translation; Identifying and Mitigating Hazards (Human Factors); Teamwork Coaching skills; Leading Change; Basic project management
· Department Heads with explicit safety roles: Green Belt (Lean Sigma); Certificate in Patient Safety and Quality
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Safety Competencies across the Organization Tool
Link in the Chain / What safety competencies have we defined as necessary for each role in our organization? / What is our organization’s development plan and what resources are available to help team members cultivate these competencies? / How do we evaluate or reinforce these safety competencies?Do we have? Y/N / What do we have? / What do we need to pursue (with who?) / Do we have? Y/N / What do we have? / What do we need to pursue (with who?) / Do we have methods already in place? Y/N / What do we have? / What do we need to pursue (with who?)
Patient and Family
Frontline Staff & Physicians
Unit Leaders
Department Heads
CEO Direct Reports
CEO
Board Members
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